Background: Uniportal video-assisted thoracoscopic surgery (VATS) has emerged as a less invasive alternative to the conventional multiportal approach in the treatment of lung cancer. The benefits of this uniportal technique have not yet been characterized in patients undergoing VATS lobectomy. This meta-analysis aimed to compare the clinical outcomes of uniportal and multiportal VATS lobectomy for patients with lung cancer.
 Methods: A systematic review was conducted using seven electronic databases. Endpoints for analysis included perioperative mortality and morbidity, operative time, length of hospital stay, perioperative blood loss, duration of postoperative drainage and rates of conversion to open thoracotomy.
 Results: Eight relevant observational studies were identified and included for meta-analysis. Results demonstrated a statistically significant reduction in the overall rate of complications, length of hospital stay and duration of postoperative drainage for patients who underwent uniportal VATS lobectomy. There were no significant differences between the two treatment groups in regard to mortality, operative time, perioperative blood loss and rate of conversion to open thoracotomy.
 Conclusions: The present meta-analysis demonstrated favourable outcomes for uniportal VATS lobectomy in the treatment of lung cancer compared to the conventional multiportal approach. However, long-term follow-up data is still needed to further characterize the benefits of the uniportal approach.

/pdf/systematic-review-and-meta-analysis-of-uniportal-versus-u1o4elgenn.pdf

Systematic review and meta-analysis of uniportal versus multiportal video-assisted thoracoscopic lobectomy for lung cancer.

It is perhaps surprising that this quotation comes from a gentleman of tradition and conservatism. However, even one of the greatest prime ministers of Great Britain recognized that we live in a constantly evolving world and adaptation is the key to survival. In surgery for lung cancer, we are witnessing a significant revolutionary change in approach that has not been witnessed since the 1990’s when major lung resection became possible through minimally invasive “key-hole” surgery in the form of video-assisted thoracic surgery (VATS) instead of through a large open thoracotomy. In 2011, as we recognized the 20 th anniversary of VATS lobectomy (1), another promising major advance in lung surgery, uniportal (single port) VATS lobectomy, was developed that has subsequently been more rapidly adopted than its parent procedure (2,3).

/pdf/uniportal-vats-a-new-era-in-lung-cancer-surgery-4jtk1z9mtj.pdf

Uniportal VATS—a new era in lung cancer surgery

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was: Are there differences in outcomes in uniport compared with multiport video-assisted thoracoscopic surgery? Altogether, 45 papers were found using the reported search, of which 8 papers represent the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type and level of evidence of publication, relevant outcomes and results of these papers are tabulated. Two studies (272 patients) compared outcomes for lobectomy. One study found pain control was significantly better in uniportal (P < 0.01) with earlier mobilization (P < 0.05), and decreased hospital stay by half a day (P < 0.05). The chest drain volume was less, and consequently the number of days the chest drain remained in situ decreased by 1 day (P < 0.05). The second study looking at lobectomies failed to find any differences between the two techniques. For minor thoracic procedures (pneumothorax, peripheral lung nodules, thymic tumours, lung biopsies, sympathectomies and mediastinal cystectomies), 3 papers (117 patients) showed a statistically significant reduction in pain score during inpatient stay, and 1 paper showed a reduction in pain score day 0 postoperatively, however, no difference in pain score days 1 and 3 postoperatively. Two papers (n = 91) showed no difference in the reported pain scores; however, the patients in the uniportal group experienced less paraesthesia postoperatively. Patients in the uniportal group in this study also had reduced in-hospital stay (P = 0.03), and this led to a reduction in inpatient costs (P = 0.03). Four other studies, however, did not find any significant difference in duration of hospital stay. Pain scores are lower in uniportal VATS, most studies however do not demonstrate differences in other outcomes including analgesic use, duration of chest tube drainage, length of hospital stay or other thoracic complications. We conclude that, although uniport access may offer improved pain scores, the current evidence reveals no differences in most postoperative outcomes between uniport and multiport approaches to VATS in either minor or major thoracic procedures.

In minor and major thoracic procedures is uniport superior to multiport video-assisted thoracoscopic surgery?

MicroRNAs are proposed to serve vital functions in the regulation of tumor progression and invasion. However, the expression levels of miR-203 in non-small cell lung cancer (NSCLC) and its clinical significance remain unknown. In the present study, the association between B-cell-specific moloney murine leukemia virus insertion site 1 (Bmi1) and miR-203 was investigated. miR-203 was demonstrated to act as a tumor suppressor by regulating the expression of Bmi1. miR-203 expression levels were downregulated in NSCLC tissues while Bmi1 expression was upregulated in NSCLC tissues and cell lines. Furthermore, downregulated Bmi1 or enhanced miR-203 expression inhibited NSCLC cell proliferation and invasion in vitro. In addition, a dual-luciferase reporter assay was performed, which identified Bmi1 as a novel target of miR-203. In conclusion, the present study demonstrated that miR-203 functions as a tumor suppressor and is important in inhibiting the proliferation of NSCLC cells through targeting Bmi1. These findings indicate that miR-203 may be useful as a novel potential therapeutic target for NSCLC.

https://www.spandidos-publications.com/10.3892/ol.2015.3080/download

MicroRNA-203 inhibits cellular proliferation and invasion by targeting Bmi1 in non-small cell lung cancer

Background
The aim of this study was to investigate which surgical method is better in lymph node (LN) dissection of lung cancer.

https://link.springer.com/content/pdf/10.1186/s12957-016-1038-7.pdf

Thoracotomy is better than thoracoscopic lobectomy in the lymph node dissection of lung cancer: a systematic review and meta-analysis

Background and objective Video-assisted thoracoscopic surgery (VATS) lobectomy is now generally accepted for patients with lung cancer. The aim of this study is to review the technology of thoracoscopic lobectomy with single utility port in the treatment of peripheral lung cancer. Methods We retrospectively analyzed the clinical data of 87 patients with peripheral lung cancer who underwent single utility port complete VATS lobectomy from February 2011 to January 2013 in the First Affiliated Hospital of Soochow University (single utility port group), and compared them with 75 patients with peripheral lung cancer who underwent conventional, 3-port VATS lobectomy in the same period (3-port group). The clinical outcomes including operation time, time to first activity out of bed, postoperative hospital stay, intraoperative blood loss, postoperative drainage volume, chest drainage duration, lymph node dissection number, postoperative complications and degree of chest pain were compared between the two groups. Results No perioperative death was observed in both groups. There was no statistical difference in operation time (151.03±25.97 min vs 156.27±26.49 min), lymph node dissection number (13.06±1.36 vs 12.61±1.56), intraoperative blood loss (188.62±47.03 mL vs 179.60±28.96 mL) and incidence of serious postoperative complications (18/87 vs 21/75) between the two groups. There were statistical differences in time to first activity out of bed (11.17±8.69 h vs 13.76±7.43 h), postoperative hospital stay (7.18±1.95 d vs 7.92±2.03 d), chest drainage duration (3.85±1.21 d vs 4.43±1.43 d) and total postoperative drainage volume (671.49±178.31 mL vs 736.93±170.39 mL) between the two groups (P<0.05). The change of vision analogue score (VAS) score between the two groups after operation was also statistically significant (P<0.01). Conclusion The completely thoracoscopic lobectomy with single utility port is a safe and feasible surgical procedure compared with conventional 3-port VATS lobectomy for selected patients.
	
	DOI: 10.3779/j.issn.1009-3419.2013.09.09

Clinical analysis of thoracoscopic lobectomy in the treatment of peripheral lung cancer with single utility port

Background

Video-assisted thoracoscopic (VATS) lobectomy with a single utility port has emerged as a new technology in recent years. The aim of this study is to review the technology in the treatment of elderly patients with peripheral lung cancer.



Methods

We retrospectively analyzed the clinical data of 21 elderly patients with peripheral lung cancer who underwent single utility port VATS lobectomy from February 2011 to February 2013 in the First Affiliated Hospital of Soochow University (VATS group). The clinical outcomes and postoperative complications were then compared to data from 32 elderly patients who underwent lobectomy by thoracotomy (TL group).



Results

No mortality occurred during the postoperative period in either group. There was no statistical difference in surgery duration, the quantity of lymph node dissection or intraoperative blood loss between the VATS and TL groups. However, significant differences existed in the postoperative hospital stay (6.19 ± 1.69 days vs. 8.22 ± 2.55 days), time to first activity out of bed (20.57 ± 7.72 hours vs. 26.81 ± 9.27 hours), chest drainage duration (4.24 ± 1.04 days vs. 5.22 ± 1.29 days), and total postoperative drainage volume (642.86 ± 158.18 mL vs. 787.81 ± 211.55 mL) between the VATS and TL groups (P < 0.05). The percentage of patients with no complications in the VATS group (85.71%) is significantly higher when compared with the TL group (56.25%, P < 0.05).



Conclusion

VATS lobectomy with a single utility port is a safe and feasible surgical procedure for selected elderly patients with peripheral lung cancer.

Video-assisted thoracoscopic lobectomy with a single utility port is feasible in the treatment of elderly patients with peripheral lung cancer.

Background and objective Video-assisted thoracoscopic surgery (VATS) lobectomy is generally accepted for patients with lung cancer. The aim of this study is to explore the feasibility of the single-operation-hole thoracoscopic lobectomy in the treatment of non-small cell lung cancer. Methods To review and analyze the single-operation-hole thoracoscopic lobectomy performed in our hospital for 113 non-small cell lung cancer (NSCLC) cases from October 2010 to October 2013. The incision for observation was 1.5 cm the eighth intercostal at the rear of the midaxillary line and the incision for operation was 2.0 cm-4.0 cm at the fourth or fifth intercostal of the anterior axillary line. The operations were performed through the single-operation-hole. Result The operation processes were smooth for all the patients without any operative mortality occurrence. Only in 5 cases was the operation hole expanded because of the occurrence of massive hemorrhage during the operation; 3 patients with postoperative complications underwent thoracoscopic lobectomy again, including 2 cases of delayed hemorrhage and 1 case of chylothorax. The average surgical duration was (178.24±31.17) min, the average blood loss was (213.56±62.38) mL, and the number of lymph nodes dissected was from 5-22. All diagnose were confirmed by pathology after operation. The average length of stay was (8.17±2.93) d. All cases recovered well during the follow-up of (2-38) months, only 5 cases had recurrence or metastasis. Conclusion The single-operation-hole thomcoscopic lobectomy for lung cancer is safe and feasible, further reducing the trauma, and can be used as a conventional treatment for early- or medium-term NSCLC..
	
	DOI: 10.3779/j.issn.1009-3419.2014.05.11

[Analysis of single-operation-hole thoracoscopic lobectomy in 113 clinical cases].

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Clinical analysis of thoracoscopic lobectomy in the treatment of peripheral lung cancer with single utility port

Video-assisted thoracoscopic lobectomy with a single utility port is feasible in the treatment of elderly patients with peripheral lung cancer.

[Analysis of single-operation-hole thoracoscopic lobectomy in 113 clinical cases].